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Biomedical subjects

N M Richards

Publications and source records attributed to N M Richards.

8 recordsLinked to original sources
PubMed1997

General practitioners' perceptions of the tolerability of antidepressant drugs: a comparison of selective serotonin reuptake inhibitors and tricyclic antidepressants.

OBJECTIVE: To examine inceptions and discontinuations of antidepressants in general practice. DESIGN: An observational study analysing data from an ongoing cross sectional postal survey. Every three months a representative sample of 250 doctors recorded prescribing activity for four weeks. This provided 4000 general practitioner weeks of recording per year. SETTING: A representative panel of general practitioners in England, Wales, and Scotland. SUBJECTS: Patients who began a new course of an antidepressant or had their treatment stopped or changed by the general practitioner between 1 July 1990 and 30 June 1995. MAIN OUTCOME MEASURES: Numbers of patients prescribed a new course of antidepressant; numbers discontinuing treatment; the ratio of antidepressant discontinuations to antidepressant inceptions; reasons for discontinuation; proportion of switches to another antidepressant. RESULTS: There were 13,619 inceptions and 3934 discontinuations of selective serotonin reuptake inhibitors and tricyclic antidepressants during the study. The number of newly prescribed courses of antidepressants increased by 116%, mostly due to an increase in prescribing of serotonin reuptake inhibitors. The ratio of total discontinuations to inceptions was significantly lower for serotonin reuptake inhibitors (22%) than for tricyclic antidepressants (33%). Differences persisted when controlled for age and sex of patients and severity of depression. However, there was more switching away from selective serotonin reuptake inhibitors when they failed (72%) than from tricyclic antidepressants (58%). CONCLUSIONS: Selective serotonin reuptake inhibitors are less likely than tricyclic antidepressants to be discontinued. A prospective study is needed in general practice to assess the implications of differences in discontinuation rates and switches on clinical and economic outcomes.

Antidepressive Agents, Tricyclic↗
PubMed1979

Tuberculin test conversion during repeated skin testing, associated with sensitivity to nontuberculous mycobacteria.

To determine whether repeating the tuberculin test after a brief interval might result in tuberculin conversion, we tested 213 healthy volunteers twice, 1 month apart, with 5 TU of tuberculin purified protein derivative (PPD). Three nontuberculous mycobacterial antigens (PPD-G, PPD-Y, and PPD-B) were also applied with the first tuberculin test. By widely used criteria, 14 volunteers (6.6 per cent) converted their tuberculin tests from negative to positive on the second testing. Whereas 13 of 103 subjects (12.6 per cent) with nontuberculous antigen sensitivity converted their tuberculin test to positive, only one of 110 subjects (0.9 per cent) with no known prior mycobacterial sensitivity converted to positive (P less than 0.005; x2 = 10.05). When retested with 5 TU of tuberculin PPD 6.5 months after the second test, nine of 13 converters reverted to negative. We conclude that tuberculin conversion may occur when the skin test is repeated at 1 month, and that boosting of cross-reacting mycobacterial sensitivity might have caused a portion of the conversions in this population of young, healthy midwestern volunteers. Sensitivity to Mycobacterium tuberculosis might also be boosted by tuberculin testing. Because the prevalence of sensitization by tuberculous and nontuberculous mycobacteria can be expected to vary in different populations, the significance of tuberculin conversion will also vary with the population being tested.

Adolescent↗
PubMed1975

Outbreaks of Serratia marcescens infections in a cardiothoracic surgical intensive care unit.

An outbreak of infections with pigmented Serratia marcescens involving 3 patients in a cardiothoracic surgical intensive care unit is reported. A respirator is thought to have been the source of pneumonia in 2 patients, and fomite spread from 1 of these is considered responsible for the induction of fatal endocarditis in the third patient. This outbreak demonstrates the rapid dissemination of a bacterial strain within the unit, several methods of dissemination, the wide variation in apparent virulence of the organism, the alterations of antibacterial host defense which made bacterial disease possible and which determined the site of infection, and the difficulties of adequate therapy. The third patient is the seventh reported with serratia infection of a prosthetic heart valve.

Adolescent↗
PubMedDate not supplied

Tuberculosis of the larynx masquerading as carcinoma.

A patient with laryngeal and pulmonary tuberculosis is described. The similarity between the clinical presentation and gross appearance of laryngeal carcinoma and tuberculosis in this patient and others reported in the literature is emphasized. Laryngeal biopsy is necessary to establish the correct diagnosis, but this must be done only after the proper precautions are taken to reduce the risk of infection to the physician performing the biopsy. Examination of the chest x-ray and acid-fast stain of the sputum are rapid and highly reliable screening tests for laryngeal tuberculosis.

Biopsy↗